Healthcare Provider Details

I. General information

NPI: 1174449912
Provider Name (Legal Business Name): KYLE MACKENZIE WHITE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S FRONT ST
HARRISBURG PA
17104-1619
US

IV. Provider business mailing address

205 S FRONT ST
HARRISBURG PA
17104-1619
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8360
  • Fax: 717-231-8358
Mailing address:
  • Phone: 717-231-8360
  • Fax: 717-231-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020775
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020775
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: